Quality of Life Profiles and Changes in the Course of Maintenance Treatment Among 1,015 Patients With Severe Opioid Dependence

Abstract

Introduction: Studies indicate that different areas of mental, physical, social and daily life functioning need to be considered in order to improve intervention outcomes in substance user patients. The aim of the study was to assess health-related quality of life (HRQOL) in patients diagnosed with opioid dependence as compared to healthy controls and patients diagnosed with depression and schizophrenia. Methods: A total of 1,015 outpatients diagnosed with opioid dependence were investigated during 12 months of maintenance treatment. HRQOL (MSQoL), addiction (EUROP-ASI), and sociodemographic characteristics were assessed. Results: HRQOL in opioid dependence improved significantly (p < .001), but was lower as compared to that of healthy controls and patients diagnosed with schizophrenia. HRQOL in opioid dependence comprises addiction-specific aspects, most importantly low material satisfaction, physical health, and social stability. Conclusions: HRQOL measurement provides valuable information for course and outcome in opioid dependence treatment.

RÉSUMÉ

Changements des profiles de qualité de vie au cours de traitement de substitution chez 1,015 patients avec des troubles de dépendance aux opiacés

Introduction: Il à été proposé que de domaines différentes de la fonctionnement mental, physique, et sociale doivent être adressés afin d’améliorer les résultats cliniques chez des patients avec des troubles addictifs. Cette étude était destinée à examiner la qualité de vie liée à la santé (QDVLS) chez des patients avec des troubles de dépendance aux opiacés, et de comparer ce groupe à la population générale, aux patients souffrant d’une schizophrénie et aux patients avec des troubles dépressifs. Méthode: 1,015 patients avec des troubles de dépendance aux opiacés étaient examinés pendant 12 mois de traitement de substitution. Les instruments administrés comprenaient le MSQoL, l’EuropASI, et les caractéristiques sociodémographiques. Résultats: La QDVLS chez les patients avec des troubles de dépendance aux opiacés augmentait significativement (p < .001) mais était plus faible que dans la population générale et chez les patients souffrant d’une schizophrénie. Des aspects de la QDVLS spécifiques aux addictions étaient observés chez les patients avec des troubles de dépendance aux opiacés, notamment un niveau plus faible de la satisfaction matérielle, de la santé physique et de la stabilité sociale. Conclusions: Les instruments de QDVLS peuvent fournir des informations utiles concernant le cours de la maladie et les résultats cliniques chez des patients avec des troubles de dépendance aux opiacés.

RESUMEN

Perfiles de calidad de vida y cambios en el curso de tratamiento de mantenimiento en 1015 pacientes con severa dependencia de opiáceos

Introducción: Estudios previos indican que diferentes areas de funcionamiento mental, físico, social y de funcionamiento diario necesitan ser consideradas con el objetivo de mejorar los resultados en pacientes con abuso de sustancias. El objetivo del presente estudio fue evaluar calidad de vida relacionado con la salud (CVRS) en pacientes dependientes de opiáceos comparados con controles sanos y pacientes con depresión y esquizofrenia. Método: 1015 pacientes externos con dependencia de opiáceos fueron investigados durante 12 meses de tratamiento de mantenimiento. Se evaluó CVRS (MSQoL), severidad de la adicción (Europ-ASI) y características sociodemográficas. Resultados. CVRS en dependenia de opiaceos mejoró de manera significativa (p < .001), pero fue menor que la de los controles sanos y los pacientes con esquizofrenia. La CVRS en dependencia a opiaceos está formada por aspectos específicos de la adicción, siendo los más importantes la baja satisfacción material, la salud física y la estabilidad social. Conclusiones. La medida de la CVRS proporciona información valiosa para el curso y los resultados en la dependencia de opiáceos.

Keywords :

• quality of life
• MSQoL
• heroin
• opioid dependence
• opiate addiction
• drug abuse
• heroin-assisted treatment

THE AUTHORS

Anne Karow, MD, is a senior psychiatrist at the University Medical Centre Hamburg-Eppendorf, Hamburg, Germany, and clinically responsible for the Psychosis Early Detection and Intervention Centre (PEDIC). Her main interest is the subjective perspective of patients with severe mental disorders and the integration of the patients’ perspective into clinical research through methods such as quality of life measurement. She participated in different studies with patients with opioid dependence at the Centre for Interdisciplinary Addiction Research (ZIS) of the University of Hamburg.

Uwe Verthein, PhD, is working at the Centre for Interdisciplinary Addiction research of Hamburg University as a Senior Researcher since 1991. He is involved in the management and conduction of several addiction research projects, and is responsible for data management and methods in empirical studies. His main research interests and activities are clinical trials and treatment evaluation, monitoring and documentation of addiction treatment, substitution treatment, and psychosocial interventions.

Ralf Pukrop, PhD, is working at the University Hospital Cologne as the Head of the Section for Clinical and Experimantal Psychology and Head of Neuropsychological Laboratory. His main research topics are dimensional diagnostics of personality disorders, neuropsychological indicators of high-risk states for psychoses, and quality of life of patients with mental disorders.

Jens Reimer, MD, has been working with marginalized patient groups (HIV-positive, injection drug users) for more than a decade. His expertise is in treatment of somatic and mental comorbidity in integrated settings. Dr Reimer is a senior psychiatrist at the University Medical Centre Hamburg-Eppendorf, Hamburg, Germany, and acts as managing director of the Centre for Interdisciplinary Addiction Research of the University of Hamburg. He is Editor-in-Chief of the journals Mental Illness and Suchttherapie, as well editorial assistant of European Addiction Research, and vice-president of the German Society of Addiction Medicine.

Christian Haasen, MD, is a senior psychiatrist at the University Medical Centre Hamburg-Eppendorf, Hamburg, Germany, and the Director of the Centre for Interdisciplinary Addiction Research (ZIS) of the University of Hamburg. His main areas of interest are treatment and health services research for the fields of alcohol and drug dependence. He is the main editor of the journal European Addiction Research.

Michael Krausz, MD, is Professor of Psychiatry at the University of British Columbia, Vancouver, Canada, and is holding the Leadership Chair in Addiction Research at the Centre for Health Evaluation and Outcome Sciences (CHEOS). He was the founder of the Centre for Interdisciplinary Addiction research of the University of Hamburg and second head of the Department of Psychiatry. His main clinical and research interest since more than 20 years are comorbid disorders in patients with severe mental illness and patients with substance abuse, with an emphasis on the subjective perspective and a self-determined idea of man.

Ingo Schäfer, MD, MPH, is a senior psychiatrist at the University Medical Centre Hamburg-Eppendorf, Hamburg, Germany, and a research fellow at the Centre for Interdisciplinary Addiction Research of the University of Hamburg. His main clinical and research interest are comorbid disorders in both patients with severe mental illness and patients with substance abuse, with an emphasis on the role of trauma and posttraumatic disorders.